Measles Outbreak in South Carolina Raises Concerns

Last year saw a surge of measles outbreaks across the United States, hitting records in terms of cases, and Scott Thorpe kept a close watch on Spartanburg County in South Carolina.

This area, situated in the foothills of the Appalachian Mountains, is home to various residents with notably low vaccination rates. Thorpe, who is the executive director of the Southern Alliance for Public Health Leadership—a nonprofit dedicated to enhancing health outcomes in the South—noted that Spartanburg’s situation isn’t all that different from other parts of the country, especially given the declining vaccination rates nationwide. It’s worth mentioning that Spartanburg County faced a measles outbreak about ten years ago, but now the local community is significantly more susceptible. The percentage of schoolchildren receiving mandatory immunizations has dropped from 95% to 90% over the past five years.

Then, just last fall, the first cases of measles were reported, leading the South Carolina health department to officially announce an outbreak at the beginning of October. Since then, over 200 cases have surfaced, showing no signs of slowing down.

“As community exposures increase, pinpointing where cases originated is getting harder,” stated Dr. Linda Bell, the state epidemiologist. The growing transmission in the community raises fears that, eventually, not all cases will be identified, particularly after the holidays when schools were closed and public health officials lost important community connections.

In South Carolina, coverage for the measles-mumps-rubella (MMR) vaccine falls below the national average, with Spartanburg County lagging behind in vaccination rates even further. Some parents who had previously hesitated are now seeking vaccinations for their children due to the immediate threat posed by measles.

Conversely, there are still many who remain vocally against vaccinations, even with the outbreak so close to home. Although local health officials are implementing measures to control the spread, an increasing number of exposure locations complicates containment efforts.

Thorpe mentioned that the outbreak likely began in a Ukrainian immigrant community known for low vaccination rates, though it has expanded beyond that population. An analysis highlighted that “antivax” sentiments are entrenched in Ukrainian society, stemming from past government failings in managing routine vaccinations that resulted in complications for many children.

Most of the recent cases in South Carolina can be traced back to exposures at local churches, but the wider community is also seeing growth in cases. With multiple exposure points for people, it has become difficult to determine the source of cases. Schools have played a significant role in the outbreak, alongside restaurants and other public spaces.

Nearly all current measles cases in the state involve children who are unvaccinated. The state health department emphasizes vaccination as the best safeguard, organizing pop-up clinics and offering mobile health units to assist in vaccination events—though they admit progress has been slow.

“To tackle this outbreak, we must boost MMR vaccination rates,” Dr. Bell affirmed.

In contrast, health officials in New Mexico managed to handle a recent outbreak more effectively, which Thorpe attributes to greater resource availability and better state-level investments.

Efforts by state health department workers are commendable, but they face challenges. With low local vaccination rates, the department is relying on other containment methods like contact tracing and encouraging unvaccinated individuals to quarantine when exposed. However, this is a labor-intensive process; recently, hundreds have been quarantined, merely a fraction of those contacted.

“Our strategy revolves around quickly identifying infectious individuals to limit further spread,” said Bell.

This involves reaching out to those who had close contact and publicizing exposure settings, which becomes harder as the number of exposures grows, with more community members potentially carrying the infection unknowingly.

For unvaccinated children, quarantine translates to a three-week absence from school—a factor the health department cautions parents about when they’re seeking exemptions from vaccination requirements. This is also a point Dr. Stuart Simko, a local pediatrician, discusses with hesitant parents, emphasizing the economic impact of missed work when caring for quarantined children.

Some families have opted for vaccinations post-quarantine, while others remain unvaccinated despite multiple quarantines, according to the state health department. Many local pediatricians report parents resisting vaccinations even after their children experience illness from measles.

In fact, Dr. Simko noted he’d only ever studied measles before, never actually seeing a case—until now, with five patients treated recently, some of the most severely ill he has ever encountered.

Watching the progression of the disease was startling for him. He recalled observing a rash develop on a child during telehealth visits while helping manage fever and hydration.

“He appeared very sick; it was clear he wasn’t well,” Simko remarked.

For hesitant parents, Dr. Leigh Bragg, another pediatrician in the area, often finds that meaningful conversations about the importance of vaccination can lead to understanding—even as many express vague concerns based on feelings or social media influence.

“It’s challenging for us as pediatricians because it’s hard to address their hesitations when they can’t specify what those are,” she noted.

Exemptions for vaccines have been on the rise across the U.S., particularly during the Covid pandemic, with religious exemptions in South Carolina nearly doubling. However, not all exemptions stem from outright anti-vaccine beliefs; some are related to broader healthcare access issues.

Thorpe pointed out that in many communities with lower vaccination rates, healthcare access struggles are significant. He emphasized the importance of the physician-family relationship—if families can’t easily access healthcare services, it becomes challenging to improve vaccination rates.

In the aftermath of Covid, schools have been focusing on getting students back to class to mitigate the risk of losing them entirely from the education system. Thorpe explained that this places schools in a tough spot: push for vaccinations or allow students to advance without them to access education and other support services.

“Often, the religious exemption seems more convenient than the effort involved in multiple visits for vaccinations,” he said, sharing that the consequences of such decisions had previously seemed minimal.

By the end of 2025, the U.S. confirmed 2,144 measles cases, marking a significant rise compared to the early ’90s, and it looks like 2026 might not fare much better. Recently, the Pan American Health Organization declared that Canada lost its measles elimination status due to an ongoing outbreak, while the U.S. also faces uncertainty regarding its long-held elimination status since 2000.

Multiple outbreaks across the country are believed to be interlinked, particularly the ones in West Texas and South Carolina. As time progresses, questions linger about the evidence needed to establish these connections, but sustained outbreaks might soon meet the criteria considered necessary for further investigation, especially with numerous quarantinees and stagnant vaccination rates in local areas.

Moreover, at least four significant U.S. airports reported measles cases or potential exposure during the busy holiday season last month, and there are concerns about possible exposures in Albuquerque related to visitors from South Carolina.

As the new year began, three measles cases were recorded: two in South Carolina and one in North Carolina, linked to family visits to Spartanburg County.